Provider First Line Business Practice Location Address:
500 MT. PROSPECT AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-485-1272
Provider Business Practice Location Address Fax Number:
973-485-2318
Provider Enumeration Date:
02/01/2007